Provider Demographics
NPI:1740385855
Name:ALI, KISHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHWAR
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 MCCOY DR STE 109
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4429
Mailing Address - Country:US
Mailing Address - Phone:630-898-1031
Mailing Address - Fax:
Practice Address - Street 1:3845 MCCOY DR STE 109
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4429
Practice Address - Country:US
Practice Address - Phone:630-898-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360998982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004526027OtherBCBS IL
IL036099898Medicaid
ILG96175Medicare UPIN
IL0004526027OtherBCBS IL